Muhammad.

Ramli

Department of Anesthesiology
Faculty of Medicine
Hasanuddin University
Makassar
 Perioperative
Pain

Pre- operative Surgery Post operative

Analgesic effect must covers entire perioperative

period, whenever the drug was administered

Neuraxial Analgesia + NSAIDs + Opioid Analgesia

Acute Perioperative Pain

 Suffering &
Poor Postoperative Unpleasant
Pain Management
Physiological &
psychological
consequences

• Stress Response •  Myocard infarction incidence

• Alterations of endocrine & • Wound healing derangement
metabolic systems • Decelerate gastrointestinal motility
• Increase of sympathetic •  work of breathing
activity •  chronic pain incidence

Reuben SR, Buvanendran A. The Role of preventive multimodal analgesia. In Acute Pain Management Sinatra SR, Editor. Cambridge University Press. Cambridge, New York, Melbourne, Madrid,
Cape Town, Singapore, Sao Paulo Medicine. 2009. 173-84
Hurley RW, Christoper LW. Acute Postoperative Pain. In Anesthesia. Miller RD editor. 7th ed. Churchill Livingstone. The United States Of America. 2010. 2783-805
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continuous to be undermanaged. Anesth Analg 2003;97:534-
 Pulse
Pain:
 Blood pressure The Fifth
Vital Sign™
 Temperature
 Respiratory rate

•American Pain Society (APS) has redefined PAIN as the 5th vital sign
June 2005
•Health care professional has to assess patients for pain every time
 SURGERY AND PAIN

Surgery

•Tissue damage Nociceptive PAIN

•Inflamed tissue input

Surgery has a biphasic insults to the body

1. Trauma to tissue
2. Inflammatory response
1.Peripheral
sensitization

ASIC/BNC
 Terjadi penurunan nilai ambang &
peningkatan respon pada nosiseptor di ujung
perifer.
 Berdampak pada hipersensitivitas pada
daerah kerusakan jaringan dan daerah
inflamasi.
 Cedera
jaringan

Nilai ambang
Ekspresi COX-2 bangkitan saraf
menurun

PGE2

Peningkatan
Membran potensial Kanal natrium
istirahat resisten TTx,
NaV1,8
2 .Central Sensitization
Spontaneous Allodynia
Tissue damage Hyperalgesia
pain
Primary Hyperalgesia

PERIPHERAL CENTRAL
ACTIVITY SENSITIZATION

Secondary Hyperalgesia
Decreased
threshold to Increased
peripheral Expansion of spontaneous
Nerve damage stimuli receptive activity
field
Peningkatan eksitabilitas sel saraf di dalam SSP, sehingga input normal
menyebabkan respon yang abnormal atau terjadi amplifikasi respon.
C. J. Woolf 2011
C. J. Woolf 2011
 10

8 Hyperalgesia Normal
Pain
Pain Intensity

Response
6 Injury
Allodynia
Hyperalgesia—
4 heightened sense of
pain to noxious stimuli
2 Allodynia—pain
resulting from normally
painless stimuli
0

Stimulus Intensity
Gottschalk A et al. Am Fam Physician. 2001;63:1979-84.
Alur Nosisepsi dan Humoral
Proses Neural (Nosisepsi) Proses Humoral (Mediator Inflamasi)

PAIN Aktivasi
COX-2
Perception
Otak

Central COX-2
Sensitization Spinal Cord Aktivasi COX-2 Sirkulasi

Modulation

Pelepasan TNF-,
IL-1β, IL-6, dan IL-
Transmission 10
Peripheral
Sensitization
Transduction

Pebedahan/ luka operas Dimodifikasi dari Reuben SS, Acute Pain Management 2009
 Pembedahan
Dua jalur

Jalur Neural Jalur Humoral

Nosisepsi Inflamasi

Transduksi
Pelepasan Sitokin
Transmisi Aktivasi COX

Modulasi

PGE2
Persepsi
 Central ACTH
COX-2 ADH
inhibition GH
TSH
COX-2

Sympathetic Norepinephrine
efferent Epinephrine
Cortisol
Aldosterone
Renin

Epidural Block
Local
Anesthetic

Cytokines
IL-1β
IL-2
IL-6
TNF
COX-2 yang berperan dalam nyeri dilepaskan dalam sirkulasi
A Working Hypothesis

Perifer Sentral (SSP)

Stimulus Noxius/Cedera Kondisi patofisiologis atau

stimulus inflamasi
IL-6?
Pelepasan Asam Arakhidonat
PGES?
COX-2
Expression of COX-2
 Prostaglandin
IL-1β

 Sensitivitas nosiseptor  Prostaglandin

perifer
Sensitisasi Sentral
Aktivasi SSP di tingkat medulla
Sensititivitas Nyeri yang
spinalis (menurunkan ambang
Abnormal
nyeri)
Nyeri
Basic principles of perioperative pain
management is to prevent, reduce or
minimize the occurrence of :

PERIPHERAL & PLASTICITY OF

CENTRAL THE NERVOUS
SENSITIZATION SYSTEM
1
• To provide sufficient
analgesia that permits (PAIN FREE)
pleasant, normal activities

2
• To prevent central
sensitization that leads to (CHRONIC PAIN)
chronic pain

3 • To improve surgical
outcome

• Early ambulation
• Early oral nutrition
• ↓ cardiopulmonary morbidity
• ↓ psychological stress, anxiety
and insomnia
• Preventing poor learning
response to future pain
episodes
Initiated by
nervous and
endocrine systems
Hipotalamus-Hipofisis-Adrenal
(HPA)

Humoral pathway Aksis hormon immunoneural

seperti :ACTH
NYERI, RESPON STRESS , NEUROENDOKRIN, DAN IMUN

TRAUMA
PEMBEDAHAN Nosisepsi
Input neuronal
aferen

sitokin
sirkulasi

Respon
Respon Immun
Neuroendokrin

NYERIr
Respon
Stress
RESPON STRES PEMBEDAHAN DAN SITOKIN
Stress Response

Hipotalamus  ACTH
 • Effective and safe
1

• Minimal side effects

2

• Facilitate recovery
3
• Easily managed (by doctors
4 or patients)
1 • PREVENTIVE ANALGESIA

2 • MULTIMODAL ANALGESIA

• MULTIMODAL PREVENTIVE
3 ANALGESIA
Preemptive Begin in early of 1920’s by Crile & Lower

Incision
(Noxious signal)

Before incision Surgery Post operative

Central nervous system (CNS) protection until post operative

period
Note :
Preemptive Pain modulation by CNS takes a place before
perception
Analgesia
Duration of the agents (ex : 2 hrs)
 1913, first idea by Crile

All experimental studies

showed “VERY CONVINCING”
1983, revival by Woolf however clinical studies were
not UNANIMOUS

1988, highlighted by wall

• Mc Quay
• Bach There is a gap between
• Tverskoy EXPERIMENTAL and CLINICAL
• Kissin INVESTIGATION.
• Kehlet
• Katz

Controversy
Defenition/ terminalogy / Administer Analgesic
Insufficient affent blokade
Patial preemptive effect in control
Intesity of noxius stimuli
“WHY IS SO”
Outcome measurement problem
1. Terminology
2. Insuficcient Afferent Blockade
3. Partial Preemptive Effect in Control
4. Intensity of Noxious Stimuly
5. Outcome Measurement

Editorial views, Anesthesiology:84(5). 1996

 Broader definition of preemptive
Incision
(Noxious signal )

Pre - Incision Surgery Post operative

or
Preventive Preventive
Analgesia Analgesia
Preventive Duration of action from the agent covering
Analgesia entire perioperative period

Duration of action from the agent is longer than preemptive target

 Preemptif
Pengobatan nyeri sebelum terjadi stimulus nyeri

Penelitian tentang preemptif masih kontroversi

disebabkan karena definisi yang berbeda

Saat ini, istilah preemptif  preventif

Preventif ( Kissin 2005)

Pengobatan nyeri sebelum, selama dan setelah

operasi (stimulus nyeri dan inflamasi terjadi).
 Pra-Incision Intraoperative Intraoperative

Central Sensitization & Neuroplasticity of Nocisepsy Input

More extent than preemptive analgesia, involved all

perioperative pain control regiment

Had more advantages than

Katz & McCartney
Its imporatant to give multimodal analgesic
therapy at all perioperative periode

Katz J, McCartney CJ. Current status of preemptive analgesia. Curr Opin Anasthesiology.2002;
15:435-41
Katz J. Pre-emptive analgesia: importance of timing. Can J Anaesth. 2001:48:105-114
 Polypharmacologic intervention nociception at
discreet points in the nociceptive pathways and
processes.

Or

• Transduction  NSAIDs (COX1 & COX2)

polypharmacologic • Transmission  Local anesthetics
manipulation of • Modulation  Opioid or NMDA antagonist
and COX2

Using 2 or more drugs which different actions

 Opioids
• Reduced doses of
each analgesic
• Improved pain relief
Potentiation due to synergistic or
additive effects
• May reduce severity of
NSAIDs, side effects of each
acetaminophen, drug
nerve blocks

1Kehlet H et al. Anesth Analog.

1993;77:1048-1056.
 PERCEPTION Combination of
OPIOID analgesics that act by
- Systemic different mechanisms
- Epidural result in synergetic
Subarachnoid analgesia
COX-2

MODULATION LOCAL ANESTHETIC

- Epidural
- Subarachnoid

TRANSMISSION

Paracetamo
l
COX-1
COX-2
TRANSDUCTION

No single drug can produce optimal analgesia without adverse

effect
 Parecoxib
Ketamine
Ibuprofen
ivNMDA
Cox-2 agents
iv antagonists

NSAIDs
iv Better analgesia
 synergy
Multimodal  additivity
Reduced side effects
Paracetamol
iv

NorAdr & iv
Opioids 5HT antagonists Local Anaesthesia
iv
Tramadol Jin et al. J Clin Anesth;13:524, 2001
Kehlet et al. Anesth Analg;77:1048. 1998
Woolf CJ, Science, 288:1765-1768, 2000
 Step 1 and Step 2 Strategies AND
Step 3 Severe
Postoperative Local Anesthetic Peripheral Neural Blockade (With or Without
Catheter)
Pain
Use of Sustained Release Opioid Analgesics

Step 2
Moderate Step 1 Strategy AND
Postoperative
Intermittent Doses of Opioid Analgesics
Pain

Step 1 Mild Nonopioid Analgesic (Acetaminophen, NSAIDs, or COX-2 Specific

Postoperative Inhibitors)
Pain AND Local Anesthetic Infiltration

Modification of WFSA analgesic ladder

Crews JC, JAMA 2002;288:629-32
By the Ladder
Acute Pain
Pain
Deminishing WFSA
Pain
Deminishing
Strong Opioid
Severe
+/- Non Opioid
Weak Opioid
Pain +/- Adjuvants Moderat
+/- Non Opioid
e Non-Opioid
+/- Adjuvants
Mild
Pain +/- Adjuvants
Pain
Par

Or

Strong Opioid
Pain Persisting Severe
+ / - Non Opioid
Or Increasing Pain +/- Adjuvants

Pain Persisting Weak Opioid

Moderat Non-Opioid Or / Par
Or Increasing e
+/-

+/- Adjuvants
Pain
Mild Non-Opioid
Chronic Pain
Pain +/- Adjuvants
WHO
Or
 Pra-Incision Intraoperative Postoperative

Combination of opiate, regional anesthesia techniques,

NSAIDs, other adjuvant analgesic

 Perioperative stress response

 Dynamic Pain (on movement)

 Postoperative Recovery & Improve clinical conditions

 Opiate consumption

 Sides effect of analgesic (no support from new literature review)

 Ketamin
Paracetamol
Gabapentin
Perception
Opioids
Gabapentinoids
Dexamethasone
Clonidine
Ketorolac
Corticosteroids
NSAID
Modulation Transduction COXIB
Local Anesthetic

Transduction
DR
G

Transmissio
Modulation n
Local
anesthetics
COXIBs Cryotherapy
 For moderate to
• acting on opioid receptors
severe pain, limited
by adverse effect in the periphery and CNS

Opioids and/or
NSAIDs combined • for controlling pain in
with local anesthetic patients after ambulatory
infiltration or intra-
articular block
surgery
 Paracetamol
Paracetamol is very safe drug as long as it is given
within recommended doses
(Adult < 4 gr/day, Infant and children 20-40 mg/kgBW)

1. Can be given to all age – from Infant to Elderly

2. From pregnant to Lactating Woman

3. Can be used for patients with renal and hepatic

impairment.
For mild to moderate pain

An effective adjuvant to opioid analgesia, and

reduction in opioid requirement by 20-30%

Paracetamol and tramadol is an effective analgesic

combination in dental and postsurgical pain
 Nonsteroidal anti-inflammatory drugs
(NSAIDs)

Nonselective
NSAIDs COX-1/COX-2
inhibitors

COX-3
inhibitors COX-2 COX-2
•Antipyretic
analgesics
inhibitors inhibitors
• Selective (coxibs) • Prefential
• Preferential
 Nonsteroidal anti-inflammatory drugs
(NSAIDs)

Diclofenac Celecoxib
Acetosal Indomethacin Ibuprofen
Ketorolac Piroxicam Ketoprofen
Meloxicam Rofecoxib COXIB
Nimesulide Valdecoxib

preferentially non- preferentially

COX-1 COX-1 COX-2 COX-2
selective
selective selective selective selective
COX
inhibitor inhibitor inhibitor inhibitor
inhibitor

anti-inflammatory
analgesic
 phospholipids
Phospholipase
arachidonic acid A2
Cyclooxygenase
COX LOX lypooxygenase
COX-2 COX-1
cyclic
endoperoxides 5-HPETE
Prostaglandin Thromboxane

PGI 2
inhibits platelet
TXA2 LTA4 Leukotriens
aggregation, stimulates platelet
vasodilator, aggregation,
vasoconstriction LTB4
hyperalgesia chemotaxis

PGD2 PGF2alfa LTC4 brochoconstriction

PGE2
inhibits platelet bronchoconstriction increase
vasodilator, myometrial contr. vascular
aggregation,
vasodilator hyperalgesia hyperalgesia permeability
LTD4

LTE4
“Shear Stress Effect”
Anesthesia Dose more than 2 mg/kg (iv) anesthesia +
produce side effects such us Psychomimetic effect

• Excessive sedation
• Cognitive Dysfunction
• Hallucination
• Nightmares

Subanesthesia Dose (Low Dose) < 1 mg/kg  demonstrated

significant analgesic efficacy without these side effects

Very Low dose (0,15 mg/kg)  single intraoperative injection of

ketamine 0,15 mg/kg improve analgesia and passive knee
mobilization 24 hour after arthroscopy
 Low-dose ketamine is not really an ‘analgesic’,
but better described as:

‘anti-hyperalgesic’
‘anti-allodynic’
‘protective’ of opioid tolerance’
 ’Treatment Opioid-induced
Hyperalgesia’
 Ketamin
Frequently Use in Postorthopedic Surgical Pain
Management

Arthroscopic A Single intraoperative injection of

Anterior Cruciate ketamin (0,15 mg/kg) improved
Ligament Surgery analgesia and passive knee
mobilization 24 hour after surgery
Outpatient Knee Improved Postoperative
Arthroplasty Outcome
When combine with epidural or
Total Knee femoral nerve block, increase
Arthroplasty postoperative pain relief for total knee
arthroplasty.
•Menigaux C, Guignard B, Fletcher D, Dupont X, Guirimand F, Chauvin M. Anesth Analg. 2000;90:129–135.
•Menigaux C, Guignard B, Fletcher D, Sessler DI, Dupont X, Chauvin M. Anesth Analg. 2001;93:606–612.
•Himmelseher S, Ziegler-Pithamitsis D, Agiriadou H, Martin Jjelen-Esselborn S, Koch E. Anesth Analg. 2001;92:
1290–1295.
•Adam F, Chauvin M, Du Manoir B, Langlois M, Sessler DI, Fletcher D. Anesth Analg. 2005;100:475–480.
 Clonidine
REDUCED DOSES
Clonidine •  Opioid postoperative
(intravenous) requirements
IMPROVED EFFECACY
• Improved Postoperative Analgesia

REDUCE SIDE EFFECTS

• Nausea and Vomiting

Cautions !!!
• Sedation and Hypotension  dose-
dependent
De Kock MF, Pichon G & Scholtes JL (1992) Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J
Anaesth 39(6): 537–44.
Jeffs SA, Hall JE & Morris S (2002) Comparison of morphine alone with morphine plus clonidine for postoperative patient-controlled
analgesia. Br J Anaesth 89(3): 424–7.
Marinangeli F, Ciccozzi A, Donatelli F et al (2002) Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain 6(1): 35–
42
 Intrathecal (SAB)
Advantages
 Clonidine 15-150 mcg + Local
anesthetic
 Prolonged time of regression
 Prolonged time to analgesic request
 Increased speed of onset and duration.
 Improved early analgesia
 Prolonged analgesia
De Kock MF, Pichon G & Scholtes JL (1992) Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia. Can J
Anaesth 39(6): 537–44.
Jeffs SA, Hall JE & Morris S (2002) Comparison of morphine alone with morphine plus clonidine for postoperative patient-controlled
analgesia. Br J Anaesth 89(3): 424–7.
Marinangeli F, Ciccozzi A, Donatelli F et al (2002) Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain 6(1): 35–
42
Inhibition of prostaglandin and leukotrienes by suppressing
arachidonic acid production thru lipocortin-induced
phospholipase inhibition

Preventing the production of cytokines

Limited use for adverse effect when given in repeated doses

for longer periods postop

Single dose of iv methylprednisolone can reduce pain

intensity and opioid consumption
 Gabapentin and Pregabalin

Morphine NSAIDs
Gabapentin Enhanced Analgesic effects
of:
COXIBs

Gabapentin can synergically with Provide anti-

and
pregabalin NSAID hyperalgesia

Superior to either
single drugs for
Pregabalin and Celecoxib postoperative pain
following spinal
fusion surgery
Eckhardt K, Ammon S, Hofmann U, Riebe A, Gugeler N, Mikus G. Anesth Analg. 2000;91:185–191.
Hurley RW, Chatterjea D, Rose Feng M, Taylor CP, Hammond DL.. Anesthesiology. 2002; 97:1263–1273.
Gilron I, Orr E, Tu D, O’Neill JP, Zamora JE, Bell AC. Pain. 2005;113:191–200.
Reuben SS,Buvanendran A,Kroin JS, Raghunathan. Anesth Analg. 2006;103:1271–1277.
Paracetamol and Gabapentin

Paracetamol Analgesic  postoperative

pain scores &
+ +
Rescue
Gabapentin Antihyperalgesic Analgesics
 • NMDA antagonist
Magnesium sulfate
• No consistent result

• Used to treat pain associated with

Lidocaine patches
post-herpetic neuralgia

Patient-controlled • Non-invasive opioid delivery

transdermal fentanyl system for acute pain management
2. WA Verri Jr. et al. Hypernociceptive role of cytokines and chemokines: Targets for analgesic drug
development? Pharmacology & Therapeutics 112 (2006) 116–138
 Providing short-term pain relief postop

 Continuous infusion of local anaesthetics is

becoming popular and prolonged analgesia

 Benefits includes reducing duration of stay and

costs, incidence of PONV, lower rates of
unexpected hospital admissions after
ambulatory surgery
 Duratio Infusion
Single Onset Continuous
Drug n solution
dose ( min ) Infusion
(h) ( μg/ml )
50 – 100
Fentanyl 5 - 10 2.5 - 4 5-10 25 – 100 μg/h
μg
10 – 50
Sufentanyl 5 2-4 1 10 – 20 μg/h
μg
20 – 50
Meperidine 5 -15 6 2500 10 – 30 mg/h
mg
Methadone 2 – 8 mg 10 6 - 10 10 – 15 0.1 – 0.3 mg/h

Morphine 1 – 5 mg 30 -60 18 10 0.05 – 0.1 mg/h

0.5 – 1
Hydromorphone 10 - 15 10 -12 5 -10 0.05 – 0.1 mg/h
mg
 Synergistically
 Decreased concentration of the local anesthetic
and a lower dose of the opioid may be possible.
 Provides better analgesia with fewer side effects

Common opioids
Common LA concentration
concentration
Morphine 10 mcg/ml Bupivacaine 0.1% (1mg/ml).
Hydromorphone 10mcg/ml Bupivacaine 0.05% (0.5mg/ml)
Fentanyl 2-5mcg/ml Ropivacaine 0.2% (2mg/ml)
Meperidine 2mg/ml

Common infusion rate : 5 – 14

cc / hr
Multimodal Therapy in Spinal Fusion

•  morphine
consumption
Pregabalin Celecoxib
•  incidence &
severity of sides
effects of opiate

Pregabalin OR Celecoxib
Bimodal

Scott S. Reuben, Asokumar Buvanendran, Jeffrey S. Kroin, Karthik Raghunathan, The Analgesic Efficacy of
Celecoxib, Pregabalin, and Their Combination for Spinal Fusion Surgery (Anesth Analg 2006;103:1271–7
Multimodal Therapy in Mayor Knee Surgery

Regional COX-2
Regiment inhibitor

•  epidural analgesic
•  opiate dose in hospital
•  pain score
•  sleep disturbances
•  patients satisfaction
• Improve knee motion (1 month
post-operative)

Buvanendran, A ,Kroin J S, Kenneth J. Tuman, T.R . Lubenow, TJ , Elmofty, D. Effects of Perioperative Administrationof a
Selective Cyclooxygenase 2 Inhibitoron Pain Management and Recoveryof Function After Knee Replacement A Randomized
Controlled Trial JAMA, 12, 290 (18) 2003
 PERAN ANTIINFLAMASI NON STEROID SEBAGAI
ANALGESIA PREVENTIF TERHADAP
INTENSITAS NYERI DAN KADAR PROSTAGLANDIN
PADA PASIEN PASCABEDAH LAPARATOMI GINEKOLOGI

Jeffri Budianto M. Ramli Ahmad, Ilham Jaya Patellongi

PENGARUH PEMBERIAN OKSIKODON ORAL 20 MG SEBAGAI ANALGESIA
PREVENTIF TERHADAP INTENSITAS NYERI DAN KEBUTUHAN RESCUE
ANALGETIK PASCA BEDAH LAPARASKOPI KOLESISTEKTOMI

Munandar Marsuki, Muh. Ramli Ahmad

 NRS diam kedua kelompok

Kelompok O (n=21) Kelompok K (n=22)

Variabel p*
Min Maks Median Min Maks Median
NRS
T0 0 1 1 3 4 4 0,000*
T1 1 1 1 1 3 2 0,000*
T2 1 3 2 1 4 3 0,007*
T3 1 1 1 1 4 2 0,000*
T4 1 1 1 1 4 2 0,000*

*Uji Mann Whitney, P < 0,05 dinyatakan bermakna.

 6

4
NRS Diam

3
Kelompok O
2 Kelompok PK
1

0
T0 T1 T2 T3 T4
Waktu Pengukuran

Grafik 1. Median perbandingan NRS Diam kedua kelompok

 NRS gerak kedua kelompok

Kelompok O (n=21) Kelompok K (n=22)

Variabel p*
Min Maks Median Min Maks Median

NRS
T0 1 2 2 4 5 5 0,000*
T1 2 2 2 2 4 3 0,000*
T2 2 4 3 2 5 4 0,007*
T3 2 2 2 2 5 3 0,000*
T4 2 2 2 2 5 3 0,000*

*Uji Mann Whitney, p < 0,05 dinyatakan bermakna.

Kebutuhan Rescue Analgetik
Tabel 6. Perbandingan kebutuhan rescue analgetik total
kedua kelompok

Kelompok O Kelompok K
Variabel (n=21) (n=22) p*
Mean ± SD Mean ± SD
Rescue Analgetik 33,75 ± 10,938 70,45 ± 16,612 0,000*

*Uji T tidak berpasangan, P < 0,05 dinyatakan bermakna.

Multimodal pain therapy
 Less postop complications
 A reduced duration of hospital stay
 Improvement in postop pain
 Better clinical outcomes
Preemptive / Preventive therapy (administration of drugs )
was consider :
Prevent central sensitization
hyperalgesia incidence
 severity of postoperative pain

- Preventive analgesia techniques, almost all of perioperative

pain stimulus can be handled ( pre-, intra and post operative )
Thank you!
FOR YOUR ATTENTION
 Dosis dan Jalur Pemberian Oksikodon

Dosis bolus Intravena

Variabel (10-15 menit) PCA Intravena` Dosis Transmukosa Oral / tablet

Remaja 12-17
0,05-1 mgkgbb 0,02 mg/kg 5 mg 10 mg
tahun

Dewasa 18-65
3 mg 1-2 mg 10 mg 10 – 20 mg
tahun

Dewasa Tua 66-

2 mg 1mg 5 mg 5 10 mg
80 tahun

Lanjut Usia >

1 mg 5 mg 5 mg 5 mg
80 tahun

Dikutip dari: kokki et al. Oxycodone for the treatment of post operative pain.
Finland: Kuopia University Hospital, Department of Anaesthsia & Operative service;
2012